Hospitals Struggle to Find Doctors

By Mark Friedman
http://www.redorbit.com

PIKE COUNTY MEMORIAL Hospital in Murfreesboro was so desperate for a doctor that it hired one who had been convicted of possession of child pornography.

Dr. Lonnie Joseph Parker worked one weekend in February at the 32- bed hospital before the hospital’s board rescinded the contract, which nearly closed the hospital because it, like other rural hospitals, didn’t have enough physicians on staff.

Rosemary Fritts, Pike County Memorial’s administrator, said she believed Parker was innocent of the charge and thought the 44-year- old doctor would have kept the hospital’s doors open for years.

Fritts managed to locate another doctor for the hospital, which is almost as hard as finding a diamond in the Crater of Diamonds just down the road. The new doctor, though, is 74 years old and has to work 8 to 5 at the hospital’s clinic and then is on call the rest of the night and on weekends.

The doctor shortage in Arkansas is getting worse as more doctors retire and younger physicians aren’t willing to work the long hours that their predecessors did. And the shortage is coming at a time when baby boomers are starting to rely more on doctors’ services.

“We have a rapidly growing demand for physician services, but we’ve been training the same number of physicians for over 20 years,” said Phillip Miller, a spokesman for Merritt Hawkins & Associates, a physician recruiting firm in Irving, Texas. “And that’s starting to catch up with us.”

One Arkansas physician who is also a member of the Arkansas House of Representatives is trying to get a handle on just how bad the doctor shortage is.

Dr. Gene Shelby, D-Hot Springs, said he’s working on a study in the Public Health Committee that will look at not only the doctor shortage but shortages in all health care disciplines.

The study is “still pretty early in the process because it’s a big issue, and it will be a multi-year project,” he said.

In the 2009 legislative session, Shelby said he might introduce a bill that forms a standing committee or task force to address the problem, as other states have done.

In 2007, 5,680 physicians had licenses to practice in Arkansas, which was up 1.4 percent from 2006, according to the Arkansas State Medical Board. However, the Medical Board can’t determine which of the licensed doctors are in active practice.

Dr. I. Dodd Wilson, chancellor of the University of Arkansas for Medical Sciences in Little Rock, said one of the problems the state has is that no department keeps records as to how many doctors are practicing or which counties need them the most.

Meanwhile, Wilson is pushing to expand the medical school by opening a satellite campus in northwest Arkansas.

That would increase the number of slots for medical students from 160 to 200.

Shelby said he wants to introduce legislation in 2009 that will provide $3 million to $4 million for a new northwest campus for UAMS.

Wilson said the Little Rock campus is too small for 200 students. “The students would have a miserable experience because they’d be crowded,” Wilson said. “They wouldn’t have enough one-to-one access to the residents and to the faculty.” But even if more doctors come out of UAMS, it probably won’t relieve the doctor shortage anytime soon, Miller said. Residency programs need to be increased, he said.

“The number of residency slots is basically more or less exactly what it was in 1988,” Miller said. “Right now there’s no plan to change that.”

To find doctors, some hospitals have turned to recruiting services while others have full-time recruiters on staff. And recruiting has become highly competitive.

Doctors coming out of medical schools have been contacted by a recruiter 50 or more times during their training, Miller said.

In the U.S., there are 6,000 physician recruiters, which is roughly one recruiter for every three doctors finishing their training in a given year, said Casey Nolan, managing director for Navigant Consulting Inc. of Washington, D.C.

Nolan is currently working with St. Vincent Health System on a five-year plan that includes physician recruitment.

Patients are already seeing the impact of the doctor shortage.

“It’s most visible in the emergency department, where you have fewer specialists,” Miller said.

Miller said more people with insurance are seeking treatment in emergency rooms rather than waiting weeks to get an appointment with their primary care doctor.

“It takes me three months to schedule an appointment with a dermatologist,” he said. “Those wait times are going to get longer. It’s all about access to the physician.”

Alarming Trends

Several shifts have taken place in the medical field that helped fuel the doctor shortage.

Miller blames the Balanced Budget Act of 1997 as one of the starting points. In 1997, Congress put a cap on the amount of Medicare money that would be spent on training doctors, Miller said. Congress will have to lift that cap before more doctors can be trained, he said.

Even if the cap was lifted tomorrow, the impact on the shortage would be limited because it takes about 10 yearsfor a student to become a doctor.

A generational and gender shift also has taken place that has lowered the number of doctors.

Most of the doctors practicing today logged in 120-hour weeks during their residency training, Nolan said.

“And so when they came out of training, they were happy to go from 120 hours a week to 80 hours a week,” he said. “That was a big improvement in their lifestyle right there.”

But today’s doctors are limited by law to 80 hours a week during their residency training. “And they have no intention of continuing to work that hard when they come out,” Nolan said.

A 2006 survey found that 63 percent of final-year medical residents said the availability of free time caused a “significant level of concern,” according to Merritt Hawkins & Associates. Five years early, only 15 percent were concerned about having enough free time.

The younger doctors view their profession as a job rather than a “give it everything you got” career, Nolan said.

“They are going after the lifestyle specialties, where they can control their hours more,” Nolan said. “And they don’t get the phone call at 3 o’clock in the morning and have to go to the emergency department and see a patient.”

As a result, it will take 1.5 new doctors to replace every retiring baby boomer doctor, he said.

Another shift lowering the number of doctors available is the number of women in medical school, Nolan said.

About 70 percent of current doctors are men, but more than half of medical students are female, Nolan said. And women doctors tend to spend more time with each patient, so they can’t see as many during the day as their male counterparts, he said.

Many of the young women doctors will want to raise a family, so they will expect to work part-time or shorter weeks, Nolan said.

Recruiting Doctors

St. Vincent Health System in Little Rock has one employee working full-time to find doctors.

“It’s going to be critical for us to continue to grow,” Keck said. He said he needs the doctors not just for the St. Vincent hospitals but for affiliated clinics around the state.

Baptist Health of Little Rock has two people full-time working on physician recruitment, said Doug Weaks, senior vice president and administrator for Baptist Health Medical Center in Little Rock.

“We are constantly looking for new [doctors] and we’re not full,” Weaks said.

The hospital is seeking several specialists, including orthopedic surgeons and neurosurgeons.

Weaks said he couldn’t release an exact dollar amount of how much Baptist spends on recruiting a year, but it’s more than $100,000 annually.

Weaks said UAMS won’t produce enough doctors to fill the need.

Of a class of 150 who registered in August 2003, 134 graduated in 2007. The class of 2008, which 150 students started in 2004, did better with 142 students graduating.

Recruiting Tips

Nolan said recruiting doctors should involve the entire hospital and the community.

“You’re trying to sell this person not just on the hospital, but on the community as a place to live,” Nolan said.

The physician’s family also needs to be recruited too, he said.

Miller said hospitals have to do everything they can to make the practice attractive to doctors. And that includes the ones that it already has because the hospital can’t afford to lose physicians.

Even trivial things could have an impact, Miller said. The hospital should make sure the doctors have parking spaces close to the hospital’s entrance, and covered parking is prized so the doctors don’t get wet when it rains.

The key is to create an attractive practice environment, where malpractice insurance is low or the hospital has plenty of operating space. Those things might be enough to attract a physician to look at the hospital.

“If you get them there, then kill them with kindness,” Miller said. “Show that they are really wanted and appreciated – that goes a long way.”